Per Shri P.N. Kashalkar – Hon’ble Presiding Judicial Member:

(1)                This complaint is filed by the Complainant Mrs.Vidyut Pradeep Samant against the Opponent No.1 - Dr.Sadanand R. Shetty and Opponent No.2 –Smt.S.R. Mehta & Sir K.P. Cardiac Institute, situated at King’s Circle, Sion (East), Mumbai, alleging medical negligence on the part of the Opponent.  According to Complainant she is resident of Kurla and Opponent No.1 is a Cardiologist and Physician and Opponent No.2 Opponent No.2 is the cardiac institute at King’s Circle, Sion.  Opponent No.1 is Cardiologist and Physician on the panel of Opponent No.2 hospital.  According to Complainant her husband Pradeep Dattatray Samant aged 46 years old was School teacher of S.K. Pant Walavalkar High School and also the CEO of Maharashtra Vidya Vikas Mandal.  She was working in the same stream in which her husband was serving.  Her husband died in the hospital of Opponent No.2 on 08.05.2008 due to gross negligence and deficiency in service on the part of the Opponent Nos.1 and 2.  She alleged that on 23.04.2008 there was training programme for primary school teachers organized by MCGM Education Department in the School.  While making arrangement for the said training programme at about 11.15 a.m. her husband became sick while talking with some teachers and MCGM officials lost his control and collapsed in the school premises.  Family Doctor  Dr.C.S. Kamble was immediately called.  He advised the Complainant to contact Opponent No.1 – Dr.Sadanand Shetty as the patient had consulted him earlier and had conducted medical check-up in the year 2007.  They contacted Opponent No.1 Doctor on telephone who told that Complainant’s husband should be taken to Mata Lachmi Hospital at Sion immediately.  Accordingly, the Complainant’s husband was taken to Mata Lachmi Hospital where Doctor examined the patient.  Said Doctor contacted Opponent No.1 on telephone and informed him that there was zero response to the left side of the patient.  Opponent No.1 then suggested that Complainant should be admitted to Opponent No.2 hospital.  The patient was accordingly shifted to Opponent No.2 hospital around 01.30 p.m. under the instructions of Dr.Shetty.  He was admitted in ICCU of the said hospital.  Complainant pleaded that Dr.Shetty was not available in the Opponent No.2 hospital at about 03.00 p.m. Doctor on duty at Opponent No.2 hospital told Complainant that patient should be taken to Jupitor Heart Scan for performing C.T. scan.  The consent of the relative was obtained by the Doctor of Opponent No.2 hospital.  The Complainant pleaded that patient had suffered a paralytic stroke and in such a case   C.T. scan was required to be done immediately.  According to Complainant when Opponent No.2 did not have basic facility of carrying C.T. scan, Opponent No.1 Doctor Shetty should not have sent the patient in said hospital.  Said act was in gross negligence and deficiency in service on the part of the Opponent No.1.  Complainant pleaded that Doctor at Mata Lachmi Hospital informed Opponent No.2 hospital that there was zero response to the left side of the patient and in such a situation Opponent No.2 hospital should not have admitted Complainant’s husband when there was no basic facility of C.T. scan machine.  Complainant pleaded that as it was a case of neurological problem without wasting time immediately the Opponent No.2 hospital should have sent the Complainant to some another hospital since they were not having C.T. scan facility.  But by showing sheer negligence, the Complainant’s husband was admitted at Opponent No.2 hospital and iteven failed to provide or make arrangement of ambulance and the patient was required to be taken to Jupiter C.T. scan in a Omni Van.  After C.T. scan was over patient was brought back to Opponent No.2 hospital at 04.30 p.m. for paralysis to the left side, the patient was fully conscious and responding to all the instructions. After returning to the hospital the nurse on duty asked Complainant if patient had patient eaten anything as she was to give some medicines.  Complainant told that patient had not eaten anything since 10.30 a.m..  Thereafter, idli was brought and was feeded to Complainant’s husband.  But patient was not comfortable while eating idli and he told to stop feeding him.  But nurse on duty told that she was instructed that Complainant’s husband should be fed at least one idli.

(2)                According to Complainant though patient was admitted around 01.30 p.m. Opponent No.1 Dr.Shetty visited the patient at around 10.00 p.m. i.e. almost after 9 hours from the time of admission of the patient in Opponent No.2 hospital.  Opponent No.1 Dr.Shetty told Complainant he would give full treatment to the patient and except paralysis there was no any clinical problem and she should not panic.  According to Complainant though on 23^rd April, 2008 her husband was having neurological problem no neuro physician visited and examined the patient and on 24.04.20085 she came to know that one Dr.Nathan visited and examined the patient around 03.00 p.m. and had prescribed some medicines.  But Complainant was not allowed to see Dr.Nathan.  According to Complainant the patient had evidently neurological problem and patient should have been put under the care of neuro physician and same was totally disregarded by the Opponents. According to Complainant medical log sheet or case papers clearly showed that required treatment was not given at proper time by the Opponents.  This is because Opponent No.1 was not neuro physician and Opponent No.2 was the hospital which was cardiac institute specialized only for cardiac related illness and problems.  According to Complainant on 24thApril, 2008 Dr.Shetty informed her that patient was finding it difficult to take food and since patient was having paralysis of the face it was difficult for him to eat food and therefore, patient should be given soft food.  On the same day Dr.Shetty prescribed to do MRI test on the patient.  Again that facility was not available in the hospital of Opponent No.2 so ambulance was arranged to take the patient to Wellspring Gurmeet Diagnostic at Chembur for taking MRI.  Complainant states that her husband was suffering from neurological problem but still Opponents admitted the patient in the said hospital, delayed treatment by sheer negligence and put the life of the patient in danger.  On 24.04.2008 in the evening patient was taken to Wellspring Gurmeet Diagnostic Centre, Chembur for MRI.  Father of the patient asked the Opponent No.1 Dr.Shetty, if patient was required to be taken to other hospital for further treatment, Dr.Shetty replied that all arrangements were available to treat patient in their hospital.  The patient was getting difficulty in taking food by mouth and the same was told to the Opponent Nos.1 and 2 but they ignored said situation. The Complainant pleaded that on 25.04.2008 the Complainant’s husband was given physiotherapy exercises by the physiotherapist and on 27.04.2008 the patient was moved out to ICU as there was no bed available in ICCU due to ingress of more patients having cardiac problems.  In the ICU the temperature of the room was very low and there was only one nurse and Complainant was told by the nurse that ICU was abnormally cool in temperature.  The patient started shivering and his body temperature shoot up steadily and since there was no mechanism to adjust the temperature the nurse put newspapers on the air conditioners and tried to elevate the room temperature.                      

(3)                According to Complainant on 28.04.2008 the patient was again shifted to ICCU and Dr.Shetty – Opponent No.1 suggested to put Ryles Tube for administering oral feeding.  Accordingly on 29.04.2008 Ryles Tube was inserted and the patient was given feeding by Ryles tube from the afternoon of 29.04.2008.  The Complainant pleaded that as the first step of treatment, her husband should have been given by giving feeding with the help of ryles tube right from 23^rd April itself and the same was not done  till 29.04.2008.  According to Complainant when patient is suffering from paralysis of left side whose facial nerve was also affected from it the patient should have been put to ryles tube but the same was postponed for five days which itself was negligence on the part of the Opponent Nos.1 and 2.  According to Complainant patient was completely alright till 27.04.2008 for more than 48 hours after admission except for paralysis and neurological problem.  He got infection in the hospital itself which also amounted to deficiency in service on the part of the Opponents.  The Complainant pleaded that Opponent No.1 Doctor was cardiologist and physician and he was not neuro physician but he chose to admit the patient of neurological disorder under him and did not provide him required treatment required for such patient.  It was necessary to advise C.T. scan immediately in Mata Lachmi Hospital.  However, C.T. scan was delayed, inserting  ryles tube was delayed.  So Opponent No.1 failed to give proper treatment at the appropriate stage and due to negligence and deficiency in service in treatment the patient ultimately died on 08.05.2008 in Opponent No.2 hospital and Complainant lost her husband and her two daughters lost their father.  This loss occurred due to negligence deficient treatment provided by Opponent Nos.1 and 2.

(4)                According to Complainant though the patient was diabetic his kidney functions were normal till patient was admitted in Opponent No.2 hospital and his diabetic condition was normal till 01.05.2008 but due to deficiency in service and due to inappropriate treatment given to the patient the patient subsequently developed chest infection which Opponents could not detect till the end and this infection which developed after 48 hours form the admission started affecting adversely the vital organs of the patient.  According to Complainant since immediate feeding tube was not inserted and feeding was given through the mouth it was likely that the food particles might have entered the lungs through wind pipe and the same had caused infection.  The patient developed swelling on the neck and it was noticed by her daughter and on 27.04.2008 same was informed to the Opponent No.1 doctor immediately but no attention was given by Opponent No.1 to that aspect of the matter.  But T3, T4 and TSH test was conducted on 02.05.2008 and the report was made available on 04.05.2008.  This clearly showed that approach of Opponents was very casual and there was negligence in giving treatment to the patient. According to Complainant after the death of her husband she and her family is suffering greatly.  Though she is Principal of primary section of school her earnings are not sufficient to provide education to her daughters or to arrange marriages of her two daughters.  The family has totally collapsed, she therefore claimed that for the negligence of Opponent Nos.1 and 2 in providing good, effective and proper medical treatment to her husband Opponents should be directed to pay a sum of `30,00,000/- by allowing this complaint.

(5)                Opponent No.1 – Dr.Shetty has filed written version and contested the averments made by the Complainant.  According to Opponent No.1 complaint is based on erroneous beliefs and misconceived ideas.  He denied that he was not properly qualified to treat the patient suffering from stroke and Opponent No.2 hospital did not have basic facilities to treat the patient suffering from stroke.  He pleaded that he was not only competent to treat the patient but had exercised reasonable care and due diligence in treating the late husband of the Complainant and Opponent No.2 hospital had all the facilities to treat the patient suffering from stroke.  According to Opponent No.1 he is leading cardiologist and internist who is attached to several hospitals in Mumbai including Opponent No.2 hospital, viz. Smt.S.R. Mehta and Sir K.P. Cardiac Institute, King’s Circle, Mumbai, D.Y. Patil Hospital, Nerul, Navi Mumbai and he was also attached to Lilavati Hospital, Bandra, Mumbai, Asian Heart Hospital, Bandra-Kurla Complex, K.J. Somaiya Hospital, Everard Nagar, Mumbai and Dr.L.H. Hiranandani Hospital, Powai, Mumbai.  He pleaded that Complainant had suppressed medical history of her late husband.  At the relevant time late husband of the Complainant had medical history of heart problem, he was suffering from diabetes, high blood pressure (severe hypertension) and high levels of cholesterol.  He had a family history of heart problems.  His mother was victim of stroke, his father had also undergone by-pass surgery and the parents of the deceased were also patients of Opponent No.1.  The patient was suffering from diseases like hypertension, diabetes, dyslipidemia and IHD when he was examined by him on 7^th May, 2007.  He underwent coronary angiography at the Opponent No.2 hospital.  He had also undergone 2D Echo Cardiogram test at the Wockhardt Hospital which showed that there was poor L V function, Ischemic Heart Disease and depressed L V Systolic function and this past medical condition of the Complainant’s husband was responsible for him suffering a stroke on 23^rd April, 2008.  According to Opponent No.1 relatives  of the patient called him on phone at around 11.30 a.m. and patient had symptoms of stroke at 10.00 a.m.   He was continuously attending to patient at Opponent No.2 hospital still on phone he advised Complainant to take the patient to Mata Lachmi Hospital at Sion and requested for a preliminary evaluation.  The resident doctor attended the patient at Mata Lachmi Hospital and in consultation with the Opponent No.1 requested that the patient be admitted in Opponent No.2 hospital.  Complainant’s husband was brought to Opponent No.2 hospital at about 01.45 p.m. when more than 3 hours had elapsed since the onset of the symptoms of stroke.  This 3 hours period is referred to as crucial time window within which time the damage due to stroke could be minimized by appropriate treatment.  It is also the crucial period within which tissue plasminogen activator is administered intravenously.  However, administering tPA  after 3 hours attended with serious risk of haemorrhage and this risk of haemorrhage increased if tPA is given without CT or MRI    scan is carried out.  According to Opponent No.1 when patient was brought in the hospital and admitted in Opponent No.2 he had immediately examined the patient and commenced investigation and treatment to the patient. He had personally supervised the medication which was given orally to the patient by the nurse.  At the same time bio-chemical investigation and an emergency CT scan was also organized.  He had also advised administration of Aspirin, Clopidogrel, Atorvastatin and Cilistozole.  The Opponent No.1 pleaded that the medicines above mentioned were continuously  given to the patient even after the clinical diagnosis and both, C.T. and MRI scans were done.  The scans in fact were carried out in order to confirm the clinical diagnosis.  Opponent No.1 pleaded that the Complainant’s husband was basically a heart patient and was suffering from uncontrollable diabetes as was confirmed from the Glycosylated Haemoglobin test carried out in Opponent No.2 hospital on 23^rd April, 2008.  This test in fact showed the control status of diabetes.  These factors referred to above as co-morbid conditions, were responsible for the brain stroke suffered by the patient.  The said stroke suffered by the patient on 23^rd April,2008 was essentially vascular in nature and not primarily neurological as has been contended by the Complainant and asserted that he was competent and qualified to treat stroke patients.  He further pleaded that Opponent No.2 hospital where Complainant’s late husband was admitted has all the requisite facilities for treating cases of paralytic strokes. Though CT scan and MRI which were advanced diagnostic tools were not available but those facilities are not pre-requisites for stroke cases.  In Mumbai many hospitals have tie-ups with specialized diagnostic centers such as Jupiter Heart Scan and Well Spring and patients are referred to such diagnostic centers for tests.  According to Opponent No.1, Opponent No.2 hospital is one of the best critical care units treating any emergency medical problems like stroke in the entire Western Maharashtra region.  According to Opponent No.1 patient’s co-morbid condition, particularly diabetes, poor body resistance, poor pumping of the heart contributed to the deterioration of the patient’s health and his ultimate demise.  He pleaded that infections are quite common in critical care settings in hospitals due to bed-ridden state of the patient.  He admitted that patient’s thyroid inflammation was not reasonably foreseen and it was not a pre-existing condition.  He pleaded that patient was treated thoroughly by him and whenever required he on requests obtained the services of Dr.Nathan who was neurosurgeon.  Advanced CT scan was done, his MRI was taken, at appropriate time Ryles tube was inserted and patient could swallow food and medicines through his mouth comfortably.  He asserted that he had examined the patient on 23^rd April, 2008 at 01.46 p.m. and immediately on arriving at a diagnosis commenced the first line of anti stroke treatment by medicines mentioned above and simultaneously he advised that CT scan at Jupiter Heard Scan should be made.  He asserted that tPA injection is required to be given within three hours of the stroke and as per the Paramount Health, Admission Request Note, the stroke symptoms commenced at 10.00 a.m. on 23^rd April, 2008 and after more than three hours this Opponent No.1 examined the patient for the first time, so administration of tPA after the crucial period of three hours would be resulted into bleeding and haemorrhage and he had not given tPA injection.  He asserted that till 29^th April, 2008 patient was in a position to orally take medication and food and when he noticed that patient was experiencing difficulties in swallowing he decided to put Ryles tube to alleviate patient’s problem.  So, from day one he asserted that he had given good and proper treatment.  He also pleaded that functioning of the kidney of the patient was also monitored by him and when needed nephrologist was also called to examine the patient on few occasions.  He asserted that in case of chronic uncontrolled diabetes organs such as the heart, brain and kidney are commonly affected.  On 29^th April, 2008 when mass lesion was noticed, ultrasonography test of thyroid was done and thereafter T3, T4, TSH and thyroid antibodies test was done.  Therefore, there was neither delay in conducting any test nor treating the patient.  The Opponent No.1 therefore, pleaded that there was no negligence on his part and that husband of the Complainant had past history of uncontrolled Diabetes Mellitus, hypertension and high level of cholesterol which led him to suffering a brain stroke and he was rightly treated by him and other Doctors at Opponent No.2 hospital.  Therefore, he pleaded that there was no negligence of any kind on his part or on the part of the Opponent No.2 and complaint should be dismissed with costs.

(6)                Opponent No.2 filed written version and contested the complaint.  Opponent No.2 denied that there was any specific omission or commission on the part of the Opponent No.2 in attending the patient which may give rise to deficiency in service and negligence on the part of the Opponent No.2.  The averments made against Opponent No.2 are vague insinuations of totally unspecific nature and they cannot constitute sufficient cause to file consumer complaint under the Consumer Protection Act.  The Opponent No.2 hospital pleaded that it has a full-fledged machinery to look after any sort of patient.  The hospital is well manned by qualified Doctors and Dr.Lata Choudhary is the Medical Director.   Hospital has provided complaint book in each room and at the reception counter.  At the reception counter there is special help desk which is manned from 10.00 a.m. to 06.00 p.m. and any relative of the patient can approach and seek help and assistance in respect of all aspects of the functioning and working of the hospital.  The hospital has got three qualified highly trained professionals available in three shifts so that any grievance or complaint of any patient or relative can be attended promptly.  The hospital has also got well trained nurses and nursing supervisors on each floor.  According to Opponent No.2  it is a super-speciality hospital catering primarily to cardiac ailments. It has number of renowned Doctors in their hospital who are attached as honorary surgeons.  There are 22 full time resident doctors who reside in the campus of the hospital and are available round the clock.  It pleaded that patient was brought to ICCU of Opponent No.2 as a transfer case from Mata Laxmibai Hospital.  Patient was earlier being treated by Dr.S.R. Shetty, Honorary Consultant attached to the hospital.  Patient’s relatives or patient did not have any complaint during the time patient was being treated at Opponent No.2 hospital.  In such circumstances, the Medical Director did not supervise or look into the line of treatment or management of the patient at that point of time.  However, upon receiving the notice from this Commission along with copy of complaint  Dr.(Mrs.) Lata Choudhari immediately conducted a medical audit of the patient’s case.  She scanned all the papers and hospital treatment given to the husband of the Complainant from 23.04.2008 to 08.05.2008.  she interviewed medical, para-medical and non-medical staff who attended the patient and got satisfied and she submitted the report.  According to Opponent No.2 patient was treated as indoor patient and he was extended the optimal line of treatment by the Specialist consultants and at all times due care and proper treatment was given to the patient and medicines and therapy as recommended by the treating doctors were administered and there has been no complaint of negligence on the part of the nursing staff or said doctors during the period patient was treated in their hospital.   It pleaded that on day-to-day basis the patient was given treatment and attention by doctors and nursing staff and also there cannot be any allegations of negligence in treating the husband of the Complainant when he was in their hospital.

(7)                It denied that husband of the Complainant died in the Opponent No.2 hospital due to any negligence or deficiency in service on the part of the Opponent No.2.  It pleaded that the hospital had treated father of the patient and therefore, Complainant’s husband was likewise was admitted in Opponent No.2 hospital.  They had taken good amount of care and had given proper treatment to the husband of the Complainant.  They had also provided arrangement to shift the patient for CT scan or for MRI scan.  According to Opponent No.2, concerned Consultants/Specialists visited patient whenever required.  It denied that required treatment was not given at the appropriate time by the Opponents.  It pleaded that Complainant was all along aware that Opponent No.2 was a cardiologist and Opponent No.2 was a Cardiac Institute, but she chose to continue the treatment of her  husband at Opponent No.2 Hospital and treatment was given properly, patient was also got examined from Neurophysician at an appropriate time.  According to Opponent No.2 its ICU or ICCU are updated and patients are shifted from ICCU TO ICU depending on the improvement exhibited by a patient.  The ICU was at all times adequately staffed and it denied that ICU was abnormally cold on 27.04.2008 as alleged by the Complainant.  It denied that infection developed due to any negligence on the part of the Opponent No.2.  It denied that response of the Opponent was casual to the infections sustained to the Complainant’s husband while he was admitted in the hospital.  It denied that the Complainant has suffered irreparable loss caused due to deficiency or negligence exhibited on the part of the Opponent Nos.1 and 2.  It pleaded that the complaint may be dismissed with costs.

(8)                The Complainant filed her own affidavit and affidavit of her one Mrs.Sadhana Jitendra Mhatre in support of her complaint besides the documents pertaining to treatment given to her husband by Opponent Nos.1 and 2.  The Opponent No.2 also filed certain documents.  Opponent No.1 has filed his own affidavit and Opponent No.2 has filed affidavit of Mr.Srinivasan Sunder Rajan, who is working as Management Co-ordinator in Opponent No.2 hospital.  Both parties have filed brief notes of arguments.  We also heard Dr.Kamat A/R for the Complainant, Advocate Mr.Narayankumar for the Opponent No.1 and Advocate Mr.C.R. Naidu, along with Mr.N.P. Dalvi, Advocate for the Opponent No.2.

(9)                The points that arise for our consideration and findings are as under:

REASONS:

(10)            It is pertinent to note that the Complainant did not adduce any evidence at all to support her charge of medical negligence against Opponent No.1 – Dr.Sadanand Shetty or Opponent No.2 – Smt.S.R. Mehta & Sir K.P. Cardiac Institute, Sion, Mumbai.  Complainant’s case was advanced before us by Dr.Kamat, who is doctor by profession but who appears in our Commission as consumer activist and helps persons like Complainant to conduct medical negligence cases.  Dr.Kamat while arguing stated that Dr.Sadanand Shetty –Opponent No.1 was cardiolist and not Neurological Physician and when he knew that Complainant’s husband was a case of paralytic stroke since Mata Lachmi Hospital Doctors had informed Opponent No.1 – Dr.Sheety that there was zero response of the left side of the patient.  According to Dr.Kamat it was the duty of Opponent No.1 Doctor and Opponent No.2 in general to refer immediately the case to Neurophysician and under his advice further treatment should have been continued.  However, for 28 hours after admission of the patient in hospital no neurophysician was summoned to examine the patient.  Secondly, Dr.Kamat further submitted that Dr.Shetty, Opponent No.1 had not examined the patient at all in Opponent No.2 hospital right upto 10.00 p.m. though the patient was admitted in the hospital of Opponent No.2 at about 11.30 a.m.  Dr.Kamat further submitted that the patient was not immediately sent for CT scan or patient was not given immediately treatment by giving crucial injection of Tpa, because such injection is required to be given within three hours from the stroke suffered by the patient.  Dr.Kamat also argued before us that Opponent Nos.1 and 2 were negligent in not putting Ryles tube into patient immediately but it was put on 29^th April, 2008, i.e. after 5/6 days since admission.   Dr.Kamat also submitted before us that not getting CT scan or MRI done immediately after the patient was admitted was the culpable lapse on the part of the Opponents and that is why patient could not be given tPA injection within a period of three hours since suffering of the stroke and therefore, all these omissions constituted medical negligence on the part of Opponent Nos.1 and 2.  This was the line of contention advanced by Dr.Kamath on behalf of the Complainant.  However, as far as medical negligence is concerned, after receipt of complaint before admitting it we had referred the complaint to Medical Superintendent, J.J. Hospital, Mumbai which is a premier Government hospital at Mumbai, in terms of law laid down in Martin D’Souza’s case by the Hon’ble Supreme Court.  We received expert opinion from J.J. Hospital.  J.J. Hospital had formed three members committee consisting of Dr.Priya Patil (Chairman), Dr.Kamlesh Jagiasi (Member) and Dr.Vijaya Rokade (Member).  As members of the said committee, they scanned the documents of hospital of indoor patient, investigation reports and made following observation:

     “

1.     Pradeep Samant was admitted on 23.04.2008 with left Hemiplegia with left facial paralysis due to Right Lentiform nucleus infarct with Diabetes & Hypertension. During the course of his stay, he was also detected to have hyperthyroidism and had persistent fever.  His fever persisted inspite of higher antibiotics and he then developed hypotension and renal failure due to sepsis, and subsequently expired on 08.05.2008.

2.     The patient was treated with antiplatelet agents, (aspirin, clopidogrel) for the stroke, antidiabetic, agents (glimepiride and later insulin), antibiotics (including broad spectrum antibiotics like Meropenem) and antimalarials for Persistent fever, treatment and monitoring of cardiac arrhythmias, and later, antithytroid drugs.  Patient also received physiotherapy for his hemiparesis.

3.     Patient was seen (as per notes) by a neurophysician on second day of admission nd also on 26^th and 28^th April, subsequently.

4.     It cannot be commented whether Ryle tube feeding should have commenced immediately after admission as though the relative has alleged that there was cough on oral feeding, there is no mention of cough/dysphagia in any of ICU doctor’s notes or notes of the treating Physician or Neurophysician.

5.     Throughout the stay, the patient was treated in the intensive care setting with monitoring of vital parameters.

6.     Thus, the treatment given was standard of care and there was no gross negligence in the treatment.”

However, no doubt this committee of experts further opined that there was no proper communication by the treating Physician to the patient/relative regarding certain aspects of treatment.  According to them since the patient was presented within one hour from the stroke thrombolytic therapy with tissue plasminogen activator (tPA) could have been ideal treatment provided with an urgent CT scan within next three hours as this modality of treatment can be administered only within three hours from the onset of symptoms.  The committee was of the view that the patient should have been immediately referred to CT scan if the hospital was not having CT scan facility or patient relative should have been directed immediately to take patient to Neuro CT Scan Centre before the patient was admitted in the hospital for further treatment.  Secondly, Neurophysician did not speak to the relatives and communicate with the patient/relative regarding patient’s illness, prognosis etc.  After making these two adverse suggestions the Committee ultimately gave information that there was no gross negligence in the medical treatment.  In this case there was communication gap between the physician and neurophysician on the one part vis-à-vis the relatives of the patient.  The patient was also not given prior information regarding option of thrombolytic therapy and option of taking the patient to a center where CT/MRI facility was available.

(11)            In the totality of the circumstances, after seeing expert opinion independently given by a Committee of experts of three Doctors of J.J. Hospital, we are of the view that the allegations of the Complainant that there was medical negligence on the part of the Opponent Nos.1 and 2 is appearing to be without any merit.  Treatment given to the Complainant’s husband was of standard of care and there was no gross negligence in the treatment as per the observations made by this Committee.  Though there was reservation about not meeting to the patient’s relatives or the direction to immediately get patient’s CT Scan or that Doctors at the hospital did not have proper communication with the relatives of the patient that cannot per se constitute medical negligence.  These are the only two lapses mentioned by the Committee of experts of J.J. hospital.  Other than these two lapses the opinion unequivocally given by three members expert committee of J.J. Hospital is that there was no gross negligence on the part of the Dr.Shetty or on the part of Opponent No.2 hospital.

(12)            Dr.Kamat submitted before us on behalf of the Complainant that this was the case of Neurological stroke and Dr.Shetty as such cardiologist should not have treated the patient, he should have referred the patient to Neurologist and he should have immediately directed patient to undergo CT scan, since CT scan and MRI was not available in Opponent No.2 hospital.  He also submitted that initially for 28 hours no Neurologist from Opponent No.2 hospital itself was called to examine the patient, however, according to Dr.Shetty the patient was brought to the hospital at about 01.30 p.m. and according to Complainant stroke had occurred at 11.15 a.m. when husband of the Complainant was making arrangement for a journey programme for school teachers in his school.  However, Paramount Health’s admission request note annexed to the complaint by the Complainant mentions the time of stroke at 10.00 a.m., whereas patient was admitted in Opponent No.2 hospital at 01.30 p.m., so he was admitted in Opponent No.2 hospital three hours after the stroke or more than three hours after the onset of symptoms of stroke and therefore, administration of tPA could not be done in the instant case because three hours had already lapsed when the patient was brought and admitted in Opponent No.2 hospital.  He also submitted before us that before administration of tPA the CT scan was necessary and even if CT scan would have been done before admission or on admission since more than three hours had already elapsed, there was no question of administration of tPA in this particular case and therefore, he countered the argument of Dr.Kamat that the patient was not given tPA within three hours though patient was brought to the hospital within three hours from the onset of symptoms of stroke.  Dr.Sadanand Shetty had categorically stated that patient was initially taken to Mata Lachmi Hospital at Sion, Mumbai on 23.04.2008.   Thus he was transferred to Opponent No.2 hospital, he was admitted in Opponent No.2 hospital at 01.30 p.m.  He learnt from relatives of the patient that patient had suffered stroke at about 10.00 a.m., so ruled out possibility of administration of tPA injection after doing CT scan at Wellspring Gurmeet Diagnostic at Centre.  Therefore, he started treatment on the basis of medical history of the patient since patient was his own patient, patient was having diabetes mellitus, patient was having history of heart stroke and he thought that patient might have suffered stroke and so made diagnosis that it was a case of heart stroke and therefore, he started treatment on that line.  But he had called Dr.Nathan on the very next day.  Dr.Kamath relying on ‘Davidson’s Principles & Practice of Medicine, 20^th Edition, took us to all types of cerebrovascular disease and pointed out that “‘brain imaging with either CT or MRI should be performed in all patients with stroke.  Exceptions to this include patients in whom the brain scan result would not influence management, such as the patient who has a stroke in the latter stages of a terminal illness.  CT scan is the most practical and widely available method of imaging the brain.  It will exclude non-stroke lesions, including subdural haematomas and brain tumours.  It will demonstrate intracerebral haemorrhage within minutes of stroke onset.  Especially within the first few hours after symptom onset, CT changes in cerebral infarction may be completely absent or very subtle, though changes usually evolve over time.  For most purposes, a CT scan performed within the first day or so is adequate for clinical care but there are certain circumstances in which an immediate CT scan is essential.  Even in the absence of changes suggesting infarction, abnormal perfusion of brain tissue can be imaged with CT after injection of contrast media (i.e. perfusion scanning).  This can be useful in guiding hyper-acute treatment of ischaemic stroke.” 

(13)            According to Dr.Kamat, the first requirement of Opponents in relation to particular case was to refer the patient even before admission for CT scan and then they should have started treatment but since this was not done there was gross negligence on the part of the opponents.  Moreover, he further contended that for the first time Dr.Shetty came to see the patient after 9 hours, though Dr.Shetty himself suggested that the patient should be admitted to Opponent No.2 hospital where he had examined the patient.  He referred to page no.76 of the complaint compilation which is the paper submitted by the Complainant, which shows that Dr.Shetty had examined the patient and he had directed investigation by taking ECG, CBC and other tests.  He had prescribed certain medicines but on this sheet there is no name of the patient mentioned, name of the Doctor mentioned but time and date is also not mentioned, on the same day consent was obtained from Complainant that the patient will have to be taken to CT scan.  It would go to show that patient was examined immediately and thereafter immediately he was admitted to hospital and treatment was started, CT scan was also in the mind of Dr.Shetty and it is mentioned at page no.76, which is Doctor’s Order sheet that S/B Dr.Shetty and he had directed to make ECG, CBC and other tests of the patient.  Dr.Kamat has said that nothing was done by Dr.Shetty, in as  much he stated that Doctor has not mentioned his patient’s name and he had not mentioned date and time, however, this was done in a hurry and therefore, the Doctor might have omitted to mention the date and time and patient’s name but this paper clearly establishes that Dr.Shetty – Opponent No.1 had examined the patient immediately after admission in the hospital of Opponent No.2.  If we see Nurse’s notes at page 177 it was revealed that at the direction of Dr.S.R. Shetty at 01.25 p.m. patient was  brought on trolley, taken on bed and his BP was checked, ECG was taken.  So, first entry about admission as per Nurse’s Notes is at 01.20 p.m. and name of the Doctor mentioned is Dr.S.R. Shetty.  Then at 02.00 p.m. patient was conscious and well oriented and he was shifted to Jupiter Hospital at 03.00 p.m. and patient received back from CT at 04.00 p.m.  All the while the patient was conscious.  All medicines were given.  This would go to show that the treatment was started in Opponent No.2 hospital of late Mr.Pradeep Samant on 23.04.2008 only at the behest of Dr.Shetty and it was started from 01.30 p.m.  Therefore, we cannot find any lacuna in the treatment adopted by DrShetty and Hospital Doctors on the advice of Dr.Shetty.  Everything was done properly and under the directions of Dr.Shetty. We are finding no substance in the submission of Dr.Kamath for the Complainant that Dr.Shetty had not at all examined late Mr.Pradeep Samant immediately after the patient was admitted in Opponent No.2 hospital at 01.30 p.m. on mere fact that on first day’s paper Dr.Shetty had not mentioned date and time of the patient or even name of the patient when treatment was given in Opponent No.2 hospital, however, care was taken to help the patient once he was admitted in the hospital.  All vital parameters were checked, he was given due medication as per instructions of Dr.Shetty.  He was sent to Wellspring Gurmeet Diagnostic Centre for CT scan and patient was returned from MR Angiography of brain back at 04.00 p.m.  MR angiography report is dated 24^th April, 2008, which concludes “Acute non hemorrhagic infarct in the right lentiform nucleus, corona radiate and parietal region along right MCA territory.” And CT scan report of Jupiter Heart Scan in respect of  Pradeep Samant dated 23.04.2008 referred by Dr.Sadanand Shetty mentions as under:

       i.            Ultrafast CT study of Brain reveals right lentiform nucleus acute infarct.

     ii.            No evidence of shift of midline.  No evidence of hemorrhage.

Thus, we are finding everything was done timely and properly as per prescribed procedure by Dr.Shetty immediately after patient was admitted in Opponent No.2 hospital and there is nothing on record to show that Dr.Shetty was negligent in treating the patient immediately.  In the circumstances, we are of the view that there is no merit in the contention of Complainant that there was negligence on the part of Dr.Shetty or Opponent No.2 in treating the patient immediately.  Dr.Shetty in his another affidavit has mentioned the causes of stroke, the diagnosis of stroke and the treatment of stroke.  The are reproduced as under:

The causes of stroke: An artery to the brain may be blocked by a clot (thrombosis) which typically occurs in a blood vessel that has previously been narrowed due to atherosclerosis (“hardening of the artery”).  When a blood clot or a piece of an atherosclerotic plaque (a cholesterol and calcium deposit on the wall of the artery) breaks loose, it can travel through the circulation and lodge in an artery of the brain, plugging it up and stopping the flow of blood; this is referred to as an embolic stroke. A blood clot can form in a chamber of the heart when the heart beats irregularly, as in atrial fibrillation; such clots usually stay attached to the inner lining of the heart but they may break off, travel through the blood stream, form a plug (embolus) in a brain artery and cause a stroke.  A cerebral hemorrhage (bleeding in the brain), as from an aneurysm (a widening and weakening) of a blood vessel in the brain, also causes stroke.

The diagnosis of stroke involves a medical history and a physical examination Tests are done to search for treatable causes of a stroke and help prevent further brain damage.  A CAT scan (a special X-ray study) of the brain is often done to show bleeding into the brain; this is treated differently than a stroke caused by lack of blood supply.  A CAT scan also can rule out some other conditions that may mimic a stroke.  A soundwave of the heart (echocardiogram) may be done to look for a source of blood clots in the heart.  Narrowing of the carotid artery (the main artery that supplies blood to each side of the brain) in the neck can be seen with a sound wave test called a carotid ultrasound.  Blood tests are done to look for signs of inflammation which can suggest inflamed arteries.  Certain blood proteins are tested that can increase the chance of stroke by thickening the blood.

Treatment of a stroke:  Early use of anticoagulants to minimize blood clotting has value in some patients.  Treatment of blood pressure that is too high or too low may be necessary.  (Lowering elevated blood pressure into the normal range is no longer recommended during the first few days following a stroke since this may further reduce blood flow through narrowed arteries and make the stroke worse.)  The blood sugar glucose in diabetics is often quite high after a stroke; controlling the glucose level may minimize the size of a stroke.  Drugs that can dissolve blood clots may be useful in stroke treatment.  Oxygen is given as needed.  New medications that can help oxygen-starved brain cells survive while circulation is reestablished are being developed.

(14)            He further mentions in paragraph 5 of his affidavit that stroke in the case of Complainant’s husband being a cardio-vascular origin, as a cardiologist, he is not only qualified but competent to treat this condition.  He is more competent to carry out procedures such as  carotid artery stenting (CAS) which is a non-surgical, catheter-based procedure which unblocks narrowing of the carotid artery lumen to prevent a stroke.  Said procedure is routinely carried out in the Respondent No.2 hospital, which hospital is also equipped to carry out Carotid endarterectomy (CEA) which is a surgical procedure used to prevent stroke by correcting stenosis (narrowing) in the common carotid artery.  He therefore asserted that line of treatment advised for Complainant’s husband was in accordance with the prevailing standard.  He also in paragraph 7 asserted that the past medical condition of the Complainant’s husband was responsible for him suffering a stroke on 23^rd April, 2008.  In the very same para he mentioned that patient was suffering from diseases such as hypertension, diabetes, dyslipidemia and Ischemic Heart Disease (IHD) and he had examined this patient on 7^th May, 2007 at Opponent No.2 hospital where he underwent coronary angiography.  So, taking all these facts into account he opined that these medical conditions of the Complainant’s husband were responsible for stroke he suffered on 23^rd April, 2008.  So, in our view Dr.Sadanand Shetty cannot be faulted if on the basis of patient’s previous history he had started treatment on the stroke patient had suffered on 23^rd April, 2008, like the one he had earlier suffered. 

(15)            He also mentioned in his affidavit that he had also called Dr.Nathan to see the patient who was neurologist.  So, we are finding no substance in the argument of Dr.Kamat when he submitted that Dr.Shetty had called Dr.Nathan after 28 hours since the patient was admitted in the hospital.  In our view, Dr.Sadanand Shetty had rightly diagnosed the ailment of the patient.  He started the treatment on the right footing, he had sent the patient for C.T. Scan at the earliest and therefore, we find no substance in the submission of Dr.Kamath that Opponent Nos. 1 and 2 were carelessness in treating the patient.  There is also no substance in the contention of Dr,Kamat that Dr.Shetty had not examined the patient for about 9 hours after admitting the patient in the Opponent No.2 hospital.

(16)            It was tried to be contended by Dr.Kamat that patient was having paralytic stroke, his left portion was paralysed, he was not responding and therefore, his taking food by mouth was painful etc.,it was difficult for the patient to swallow solid food and medicines given through mouth and therefore, Dr.Shetty should have put the ryles tube immediately and that he should not have waited till 29^th April, 2008.  However, Dr.Shetty mentioned in his affidavit that till the patient was in a position to consume the medicines he had not put ryles tube but when he found that it was absolutely necessary to insert ryles tube he got it inserted under his personal supervision, which fact was also noted in the Nurse’s Chart.  He stated in paragraph 25 of his affidavit that there was no delay in insertion of rules tube and the same being need-based  was inserted once it was determined that the patient experienced difficulties in oral intake of food and medicines.  So, on this count also the explanation submitted by Dr.Sadanand Shetty is appearing to be just and proper and there seems no substance in the arguments of Dr.Kamat that putting of ryles tube was delayed by Dr.Sadanand Shetty for about 5/6 days.  According to Dr.Sadanand Shetty the stroke suffered by the Complainant was vascular problem caused due to diminished blood supply to a particular part of brain in the case of Complainant’s husband, cause of stroke was because of his co-morbid medical condition like diabetes, hypertension, dyslipidemia and IHD and strong family history and since there was strong possibility of thromboembolic source from the heart in view of his poor LV function and irregular heart rhythm, he thought it fit to rely on the medicines he had given and those medicines were continued even after the neurophysician had examined the patient and had seen CT scan and MR reports.  According to Dr.Shetty neither CT scan nor MRI scan are sine quo non for detecting strokes.  Thus, we are finding that the case presented by Complainant alleging medical negligence on the part of the Opponent Nos.1 and 2 is appearing to be without any substance.  The husband of the Complainant was basically suffering from four major diseases i.e.Diabetes, Hypertension, Dyslipidemia and IHD and that is the reason why he suffered further stroke on 23.04.2008 which ultimately proved to be fatal despite of best treatment given by Opponent No.1 in the hospital of Opponent No.2.  Everything was tried to be done looking to the symptoms exhibited by the Complainant and despite of all efforts late Pradeep Samant, ultimately expired on 08.05.2008. 

(17)            No doubt, expert Committee of J.J. Hospital has found that the Doctors in hospital were not careful in giving due information to the patient and in not sending the patient to CT scan immediately, however, these lapses cannot be said to be of a grave nature to bring the charge of medical negligence to the home of both the parties for the simple reason that the Committee in its report clearly recorded finding that “throughout the stay, the patient was treated in the intensive care setting with monitoring of vital parameters.  Thus, the treatment given was standard of care and there was no gross negligence in the treatment.”  

(18)            This finding of expert committee is important for appreciation of evidence on record and in the light of this finding, we are not inclined to hold that Opponents were guilty of medical negligence though there may be lapses on their part as high lighted by expert committee in its last two recommendations.  In any view of the matter we are finding that there is no substance in the complaint filed by the Complainant against both the parties.  Thus, taking all the facts and circumstances of the case on record, we are of the view that the Complainant has failed to establish any charge of medical negligence on the part of Opponent Nos.1 and 2.  In the circumstances, we are inclined to pass the following order:

O  R  D  E  R

                   (i)          Complaint stands dismissed. 

                 (ii)          No order as to costs.

               (iii)          Inform the parties accordingly.

Pronounced on 15^th June, 2012.